tbuckley/cabot-search huggingface dataset:
Implementation of a secure mobile application to improve care of patients with breast cancer: Experience from a medically underserved area.
Authors: Biplov Adhikari, Anurag Marasini, Mahsa Mohebtash, Maen Jamal Farha
Journal: Journal of Clinical Oncology (2023)

e18701 Background: Breast cancer care is complex and requires coordination of interdependent events and patient communication to reduce delays and missed treatments. Preliminary research has suggested that mobile health interventions may be more user friendly and can impact disparities. We report a feasibility pilot use of a HIPAA compliant mobile application developed based on human factors research to allow patient navigators and care teams to discuss cancer patient care, share information and allow chat and text communication with patients and their invited support. Methods: We offered 26 consecutive newly diagnosed breast cancer patients the option to enroll in the study at the start of the treatment. Consenting patients were trained and invited to download and install the mobile application: MyCureTeam. The patients had the option to invite their loved ones or to designate a surrogate on their behalf. The surrogacy would help overcome adoption barriers like not having a smartphone or difficulty navigating the mobile application. We invited patients completing four or more weeks of use to complete a 27 questions survey consisting open-ended questions to be responded on a five-point Likert-scale to obtain qualitative data regarding their perception of the mobile application and its utility navigating their breast cancer journey. We offered patients completing the survey a $20 gift card. We started the project as a quality improvement initiative. We obtained ethical approval prior to dissemination of the results. Results: 25/26 patients consented to using the application. All patients were female with median age of 64.5 yrs (range: 41-87). 17 (68.0%) were above the age of 60 yrs. 19 (76.0%) women were non-Hispanic African-American. 5 patients designated surrogates on their behalf. All the surrogates were children. 35 invitations were sent to participate in patient care; the acceptance rate was 80%. 16 patients completed the follow-up survey. 94% of patients found it easy to download and use the application. Patients used the application to communicate with their providers, invite their support, check their tumor profile, and check on appointment and treatment schedule. A large majority agreed it provided support, made their care easier, would use it throughout their treatment, and would recommend it to other patients. 36% of patients used the patient portals and 75% preferred the App to the portal. Conclusions: This experience supports the feasibility of using a mobile application for patients to communicate with care team, involve their support, give access to details regarding the tumor, keep track of appointments and interventions. The concept of surrogacy in digital health needs further investigation as does involving patients’ support. The adoption rate of 96% in a largely elderly black population from a medically underserved area warrants further investigation.
Thoracic SMARCA4-deficient cancer descriptors and clinicopathologic determinants of survival: Analysis of a pooled database.
Authors: Frankie Lee Powell, Philip A. Haddad
Journal: Journal of Clinical Oncology (2023)

9049 Background: Inactivation of SMARCA4, a catalytic subunit of the SWI/SNF complex, has been linked to high-grade aggressive cancers with poor prognoses. SMARCA4-deficient thoracic tumors (SDTT) can involve any part of the chest cavity, including the lungs, mediastinum, pleura, and chest wall. SDTT’s detailed clinical features and optimal treatment still need to be clarified. Therefore, we conducted this pooled database analysis to delineate key clinicopathological characteristics, prognostic indicators, and treatment modalities that affect survival in this unique group of thoracic cancers. Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 120 cases of SDTT. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 120 patients with confirmed SDTT were identified. The median age was 54, with a peak incidence between 56 and 68. There was a male preponderance with M:F of 3. The median duration of symptoms before diagnosis was 3.5 months. Patients presented with local disease in 11%, locally advanced in 21%, and metastases in 61%. The primary sites were the lungs (45%), mediastinum (42%), and pleura (13%). Common metastatic sites were bone (32%), adrenals (30%), liver (20%), Brain (20%), and lungs (18%). The median OS of the whole group was 6 months. Ninety percent of patients had a smoking history with a median of 26 pack-years. Histology comprised epithelioid/rhabdoid (79%) and carcinoma (adenocarcinoma, mucinous, and undifferentiated, 21%). Carcinomas had a better median OS than sarcomatous histology (11 vs. 6 months, p=0.03). Furthermore, early stages (N0/N1) had a superior median OS compared to advanced stages (N≥2, M+) (16 vs. 5 months, p=0.02). Compared to no treatment, local therapies (surgery (S) or radiation (RT)), combination chemotherapy (CT), and combined modalities (CT±S/RT) were statistically superior with a median OS of 1, 4, 6, and 11 months, respectively (p&lt;0.0001). Further analysis revealed CT+S had superior median OS to CT+RT (16 vs. 9.5 months). Moreover, those with immune checkpoint inhibitors incorporated into their therapies had the best median OS outcomes (p&lt;0.0001). Age, sex, primary site, and size did not impact OS. Conclusions: This study presents updated clinicopathologic data from a pooled cohort of patients with SDTT cancers. It identifies the histologic type, stage, and treatment approach as critical determinants of OS.
FISH abnormalities in Agent Orange–associated multiple myeloma.
Authors: Jeries Kort, Timothy O'Brien
Journal: Journal of Clinical Oncology (2023)

e20056 Background: Multiple myeloma (MM) is a plasma cell neoplasm that accounts for approximately 10% of all hematologic malignancies. Molecular investigations have identified a wide heterogeneity in MM at the genomic and epigenomic levels, often with IgH translocations and trisomies seen early in the pathogenesis. Etiological factors, though, are still not well characterized. Agent Orange (AO) was a herbicide widely used as a defoliant by the U.S. military during the Vietnam War. Studies have indicated a probable causative link between exposure to AO and the development of multiple myeloma; in fact, MM is now recognized by the VA as a service-connected diagnosis. However, there have been few small studies addressing whether there are any unique molecular findings in AO associated MM. We sought to determine if there were any specific myeloma FISH abnormalities seen in AO associated MM and if there were any differences in their respective survival. Methods: We included all patients diagnosed with MM from 2010-2022 at Louis Stokes VA Medical Center (Cleveland, OH). Data collected included: age, sex, race, year of diagnosis, AO exposure, bone marrow biopsy results and myeloma FISH panel results. We defined high risk MM based on the presence of t(14;16), t(14;20), del 17p/TP53 or gain 1q. Overall survival (OS) was calculated from date of diagnosis to death. Results: We included 162 patients with MM, among them 32 had AO exposure. There was no significant difference in age or race between exposed and non-exposed patients. MM FISH results were available for 137 patients. Overall, 20% of patients had high risk group cytogenetics and there was no significant difference based on AO exposure. However, there was a trend for increased TP53 mutations in those exposed to AO, although this did not reach statistical significance (8% vs. 3.6%, p = 0.3). Median OS was 72 months for non-exposed patients and 98 months for exposed patients, with no significant difference observed (p = 0.18). Conclusions: In this single institution, retrospective study, AO exposure was not associated with a higher incidence of high-risk cytogenetics by FISH in MM. There was a trend for increased TP53 mutation with AO exposure, but the cohort was small and did not reach statistical significance. In addition, AO exposure was not associated with a worse survival. Further studies are needed to clarify the effects of AO on the development of MM, including genomic and transcriptomic analysis to elucidate the pathobiology of this disease. [Table: see text]
Independent prognostic value of method of detection in lung cancer: Analysis of the PLCO lung screening trial.
Authors: James Patrick Long, Yu Shen
Journal: Journal of Clinical Oncology (2023)

e22526 Background: Prognostic models in cancer use patient and tumor characteristics to predict survival and disease progression. Many tumors are detected as part of screening programs such as colonoscopy for colorectal cancer, mammograms for breast cancer, and pap tests for cervical cancer. Past work in breast cancer has shown that screen detected tumors exhibit better prognosis than symptom detected tumors. The prognostic significance of method of detection in other types of cancers is less well understood. Further, the importance of method of detection, relative to other prognostic variables such as sex, age, cancer stage at diagnosis, and histology, is largely unknown. Methods: The prognostic significance of method of detection in the PLCO Lung cancer screening trial was investigated. PLCO randomized patients to intervention, with four annual chest x-ray (CXR) screenings, or control, usual care. Patients were followed for a total of approximately 13 years. All patients diagnosed with non-small cell lung cancer within 4 years of randomization were considered in the analysis (N = 934). Cox proportional hazards model and Random Survival Forests were used to build prognostic models to predict overall survival. The importance of each variable in prognostic models was assessed using hazard ratios and Random Forest variable importance measures. Results: Screen detected tumors exhibit stage shift and have better prognosis than interval and control detected tumors. The improved prognosis remains significant after controlling for stage at diagnosis and other variables commonly used in prognostic models (e.g., age, histology, sex). Variable importance measures show that method of detection is a more important prognostic indicator than sex and histology. Results are robust to different methods for cohort selection. Conclusions: Method of cancer detection should be considered when developing prognostic models in lung cancer studies. Cancer registries should routinely collect method of cancer detection.
Estimated value-based pricing for blood-based colorectal cancer screening test versus multi-target stool DNA test.
Authors: John B. Kisiel, A. Mark Fendrick, Bijan J. Borah, Derek W. Ebner, A. Burak Ozbay, Vahab Vahdat, Chris Estes, Paul J. Limburg
Journal: Journal of Clinical Oncology (2023)

e18911 Background: Stool-based colorectal cancer (CRC) screening with the multi-target stool DNA (mt-sDNA) test is a guideline endorsed strategy for average-risk individuals age ≥45 years and provides a reference for value-based pricing (VBP); maximum price at which a willingness-to-pay threshold is reached. Blood-based tests (BT) are an emerging screening option. Using recent reported BT performance data from the ECLIPSE study (Guardant Health, Inc.) 1 , the potential VBP of BT compared with multi-target stool DNA (mt-sDNA) was analyzed. Methods: Using the validated CRC-AIM model, we simulated a cohort of 2 million average-risk individuals who received screening with BT at 1, 2, or 3-year intervals or triennial mt-sDNA between the ages of 45-75 years. For BT, CRC sensitivity, advanced adenoma sensitivity, and specificity were based on reported clinical trial data (83%, 13%, and 90%, respectively). Adherence assumptions for BT and mt-sDNA screening were modeled at perfect (100%) or real-world mt-sDNA adherence (RWE). Key outcomes were life-years gained (LYG) per 1000 individuals vs no screening, and VBP of BT vs mt-sDNA ($895 vs $508) was assessed at a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year. Results: The triennial mt-sDNA was more effective and less costly vs BT at all intervals with both perfect and RWE adherence at the current price. Compared with mt-sDNA screening, LYG of screening with BT was lower (320 vs. 241-314) and the VBP should be at most $49 and $11 and no-cost at the 1-, 2-, and 3-year intervals, respectively (Table), when perfect adherence is assumed. With RWE adherence, the LYG with mt-sDNA was 306 compared to 229-284 with BT across all intervals. To be comparable to RWE triennial mt-sDNA screening, the maximum VBP for BT would need to be $13 at the 1-year interval and no cost for 2- and 3-year interval. Conclusions: Compared to annual, biannual, and triennial BT, triennial mt-sDNA was more effective at all intervals and 44% to 102% less costly. The maximum price of BT should not exceed $49 to be considered a cost-effective option compared to mt-sDNA when WTP is 50,000. [Table: see text]
Outcomes of venous thromboembolism among cancer patients admitted with COVID-19: A nationwide inpatient sample analysis.
Authors: Muhammad Bilal Ibrahim, Rafaella Litvin, Hiba Noor, Ali Husnain Khan, Mihir Shah, Philip Onyekaoso Kanemo, Maria Cristina Cuartas Mesa, Ekrem Turk, Ayobami Gbenga Olafimihan, Jay Vakil, Vaishali Deenadayalan, Kunnal Batra
Journal: Journal of Clinical Oncology (2023)

e18823 Background: Cancer patients are at a higher risk of venous thromboembolism and fatal pulmonary embolism due to inflammatory cytokines, reduced coagulation inhibitors, microparticles, and other molecular mechanisms. COVID-19 leads to endothelial inflammation and microthrombi formation, further aggravating the baseline profound risk among cancer patients, with subsequent worsened mortality and morbidity. We sought to explore the outcomes of COVID-19-associated VTE in cancer patients. Methods: National Inpatient Sample 2020 was used to identify hospitalizations of cancer patients with COVID-19 with a secondary diagnosis of venous thromboembolism. All cancer patients with COVID-19 were stratified into two cohorts based on the presence of venous thromboembolism. The primary outcomes examined were In-patient mortality, the average length of stay (LOS), and total hospital charge (THC). Multivariate analysis was performed to obtain the odds ratio. All weighted analysis was conducted through STATA 17. Results: Using NIS 2020, 36,285 hospitalizations were identified with cancer and a primary diagnosis of COVID-19. Among cancer patients with COVID-19, the presence of any type of venous thromboembolism was associated with increased mortality(aOR: 1.7 CI: 1.36- 2.11),length of stay(11.62 vs. 7.73 days p &lt; 0.01) and total charges($141,049 vs. $79,238 p &lt; 0.01). Pulmonary embolism was similarly associated with increased mortality (aOR: 1.42 CI: 1.08- 1.88), LOS(9.27 vs. 7.92 days p = 0.015), and total charges($107,111 vs. $82,180 p &lt; 0.01). Venous thromboembolism other than PE was associated with increased mortality at a higher adjusted odds ratio (aOR: 2.12 CI: 1.52- 2.96), as well as longer LOS(15.71 vs. 7.79 days p &lt; 0.01) and higher total charges($200,999 vs. $80,406 p &lt; 0.01). Conclusions: This study shows that venous thromboembolism among cancer patients with COVID-19 leads is associated with increased mortality and economic costs. VTE other than PE appears to be associated with less favorable odds than PE. Physicians should maintain a higher degree of suspicion for venous thromboembolism when treating cancer patients with COVID-19. Optimum thrombotic prophylaxis, timely diagnosis, and treatment of venous thromboembolism are critical to reducing the deleterious outcomes. [Table: see text]
The impact of patient demographics on involvement in cancer care decisions in the US.
Authors: Margaret Brierly, Anthony Drago, Angelena Moseley
Journal: Journal of Clinical Oncology (2023)

e18746 Background: As the oncology market continues to expand and more treatment options become available, the potential for highly personalized cancer care increases. In recent years, emphasis has been placed on patient involvement in treatment decisions, aiding physicians in generating care plans that focus on individual preferences and priorities. Shared decision making between patients and healthcare providers has been shown to improve patients’ perceptions and quality of life throughout the continuum of care (1). Methods: The Ipsos Global Oncology Monitor is an online, multi-center medical chart review of oncology patients receiving drug therapy. 470 cancer-treating physicians in the United States were screened for seniority and caseload and submitted data on 64,124 cancer patients (aggregate; all tumour types) between January 2022 to December 2022. Data included tumor type, age, gender identity, ECOG performance score and treatments received. The level of patient involvement in care decisions was determined by sampled physicians and recorded on a scale of 1-10 (1 = low involvement, 10 = high involvement). Results: Reported patient engagement with treatment was generally high, with an average involvement score of 7.50. 45% of sampled physicians rated patient involvement as a score of 9 or higher. In comparison to the entire study pool, reported patients diagnosed with breast cancer (7.89), non-small cell lung cancer (7.66), non-Hodgkin’s lymphoma (7.85) and colorectal cancers (7.64) all had significantly higher average involvement levels (p &lt; 0.05). In contrast, individuals diagnosed with prostate tumors or myeloma recorded ratings significantly lower than the average (7.03 and 7.44, respectively). In relation to gender identity, reported female patients were significantly more likely to be engaged with their care decisions (7.70) than their male counterparts (7.25). Additionally, ECOG performance scores and individual involvement seemed to align: patients with an ECOG score of 0 had the highest rated involvement (7.82) and as ECOG scores worsened, the average scores fell near or below the wider reported patient cohort mean. Conclusions: Results from this study highlight that reported US patient involvement in cancer treatment decisions is generally high, reinforcing the importance of joint evaluation in bettering care outcomes. However, specific patient cohorts are more likely to be highly involved than others. These discrepancies merit a more conscious effort to support patient engagement and continue improving quality of care. Further investigation using comparator cohort is warranted. https://participatorymedicine.org/journal/columns/innovations/2017/04/13/the-future-of-patient-engagement-in-the-oncology-setting-how-practical-patient-engagement-recommendations-and-innovative-inter-professional-education-can-drive-change/.
A theranostic approach: Imaging and therapy of delta-like ligand 3–expressing small cell lung cancers.
Authors: Salomon Tendler, Tran T Hoang, David Bauer, Joshua Korsen, Alexa Michel, Roberto Degregorio, Lukas Carter, Nagavarakishore Pillarsetty, John T. Poirier, Jason Stuart Lewis, Charles M. Rudin
Journal: Journal of Clinical Oncology (2023)

8575 Background: Small cell lung cancer (SCLC) is a highly radiosensitive tumor, with selective cell surface expression of the inhibitory Notch ligand Delta-like ligand 3 (DLL3). This facilitates targeted radionuclide therapy accompanied by complementary imaging agents to evaluate and monitor disease progression. The project aims to identify the next generation of DLL3-targeting radioimmunoconjugates to improve the clinical outcome for SCLC patients. Methods: In collaboration with the Tri-Institutional Therapeutics Discovery Institute, we screened and assessed &gt;100 humanized antibodies for their binding affinities, internalization rates, and other pharmacodynamic properties. Here, we present data on two leading candidates (mAb1 and mAb2) holding highest promise in both imaging and therapy studies conducted in DLL3-expressing SCLC tumors. For in vivo imaging, antibodies were radiolabeled with Zirconium-89 ( 89 Zr), which allows for immuno-positron emission tomography (immunoPET). Therapeutic studies were performed with the same antibodies conjugated with Lutetium-177 ( 177 Lu). Human SCLC NCI-H82 xenografts were implanted in nude athymic female mice. ImmunoPET scans were acquired during multiple time points post-injection of the imaging agent, and terminal biodistribution analysis was performed. Treatment studies included administration of 400 and 600 Ci 177 Lu-conjugated antibodies in cohorts of mice, with appropriate positive and negative controls. Results: Both lead antibodies demonstrated efficient radioconjugation with either isotope. ImmunoPET imaging utilizing 89 Zr showed specific high-level tumor uptake for both clones with low background in non-tumor organs. Ex vivo gamma counting biodistribution analysis, performed 120 hours post-injection, confirmed these findings. Dosimetry estimates suggested a similar therapeutic index between the two clones, with the bone marrow being the dose-limiting organ. Preliminary results from therapy studies demonstrate a statistically significant (p &lt;0.05) prolonged overall survival for the experimental arms compared to controls, and include durable tumor responses. As expected for radionuclide therapy, transient hematologic suppression was observed within 7-10 days after the beginning of the treatment, with normalization of blood cell counts for all groups within three weeks. Conclusions: This study highlights the promise held by novel DLL3-direct radioimmunoconjugates as a diagnostic tracer, prognostic biomarker, and therapeutic agent. Both lead candidates appear promising for translation as both imaging and therapeutic agents for patients with SCLC.